# Pregnant women’s and health workers’ perceptions and experiences on the Rwandan ANC digital module intervention at selected health centres

## TL;DR

This study explores how a digital antenatal care tool was accepted and used in Rwanda, highlighting both benefits and challenges in its implementation.

## Contribution

The study provides insights into the real-world experiences of health workers and pregnant women with a digital ANC module in Rwanda.

## Key findings

- The digital module improved tracking, data storage, and reporting for antenatal care.
- Participants noted challenges such as slow system performance and increased workload.
- Strengthening system performance and supervision could support future scale-up of the tool.

## Abstract

As part of the New Antenatal Care Model for Africa and India (NAMAI) study, Rwanda implemented a digital module, in line with national digital health strategies, and the WHO SMART guideline framework. The purpose of this NAMAI study was to evaluate the acceptability and feasibility of implementing an updated national Antenatal Care (ANC) service package and the use of a digital tool to support and improve quality service provision. A qualitative component was conducted to explore the experiences of health workers and pregnant women on the implementation of the Rwandan digital ANC module intervention in study facilities. This qualitative study was conducted in 14 health centres in Nyanza and Nyagatare districts. A total of 13 heads of health centres and 14 nurses/midwives providing ANC services participated in Key Informant Interviews (KIIs). In addition, 10 Focus Group Discussions (FGDs) were conducted, each composed of seven to nine pregnant women. Data were collected in December 2024 using KII and FGD guides. All KIIs and FGDs were audio-recorded, transcribed verbatim and translated into English. Transcripts were analyzed employing using inductive thematic content analysis techniques with Atlas.ti Version 8. The Rwandan ANC digital module intervention was perceived to enhance tracking and follow up, improve data storage and reduce risk of record loss, simplify data analysis and reporting, and provide reminder notifications. However, some implementation challenges were highlighted, including slow performance of the digital tool, inadequate supervision, and increased workload due to the use of concurrent paper and digital tools. Despite the perceived benefits of the Rwandan digital ANC module intervention, the study identified some challenges that may hinder its effective implementation. To optimize the delivery of ANC services through this digital tool and inform future scale-up, it is essential to address the mentioned challenges.

Digital health tools are increasingly used to improve the quality of maternal healthcare, but putting them into practice in low-resource setting remains difficult. Rwanda introduced a digital antenatal care (ANC) module aligned with the national digital health strategies and the WHO SMART guideline framework. This study explored how health workers and pregnant women experienced with the introduction of this digital tool in routine ANC services. We conducted interviews with heads of the health centres and nurses/midwives, as well as focus group discussions with pregnant women in 14 health facilities across two districts in Rwanda. Participants reported that the digital module improved the follow up of pregnant women, strengthened data storage, reducing the risk of losing records, simplified reporting and enabled timely reminders. At the same time, they highlighted key barriers, including slow system performance, limited supervision and the increased workload caused by using both paper and digital tools. Thus, strengthening system performance, reducing duplication of work and improving ongoing supervision could enhance service delivery and guide for future national scale-up.